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J Electrocardiol. 2014 Nov-Dec;47(6):769-74. doi: 10.1016/j.jelectrocard.2014.07.019. Epub 2014 Aug 2.

Comparison of three ECG criteria for athlete pre-participation screening.

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Stanford Health Care, Stanford, CA, USA. Electronic address:
Stanford Health Care, Stanford, CA, USA.
Gunn High School, Palo Alto, CA, USA.
VA Palo Alto Health Care System, Palo Alto, CA, USA.


Controversy regarding adding the ECG to the evaluation of young athletes centers on the implications of false positives. Several guidelines have been published with recommendations for criteria to distinguish between ECG manifestations of training and markers of risk for cardiovascular (CV) sudden death. With an athlete dataset negative of any CV related abnormalities on follow-up, we applied three athlete screening criteria to identify the one with the lowest rate of abnormal variants.


High school, college, and professional athletes underwent 12L ECGs as part of routine physicals. All ECGs were recorded and processed using CardeaScreen (Seattle, WA). The European (2010), Stanford (2011), and Seattle criteria (2013) were applied.


From March 2011 to February 2013 1417 ECGs were collected. Mean age was 20±4years (14-35years), 36% female, 38.5% non-white (307 high school, 836 college and 284 professional). Rate of abnormal variants differed by criteria, predominately due to variation in interval thresholds for QT interval and QRS duration. There was a four-fold difference in abnormal variants between European and Seattle criteria (26% v 6%).


The Seattle criterion was the most conservative resulting in 78% fewer abnormal variants than the European criteria. Variation was most evident with thresholds for QT prolongation, short QT interval, and intraventricular conduction delay. Continued research is needed to further understand normal training related adaptations and to improve modern ECG screening criteria for athletes.


Athlete screening; Electrocardiogram criteria; Pre-participation screening; Seattle criteria

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